The Renal Diet Recipes

Much of food TV, food writing and of course, food blogging, is aspirational, part of a ‘lifestyle’: female chefs on TV are always young, slim and unsweaty, food writing is often about rare and expensive ingredients and time-consuming methods, while food blogging can be so twee. Who ties up their freshly-made cookies with ribbon? Who always drinks from a retro paper striped straw? As a self-confessed food geek, I’m always trying hard-core DIY recipes so I plead guilty to the second sin. And I am sometimes prone to the third vice, of prettying up my food photography and recipes, unlikely to be replicated by the average, home tired-from-work cook.
But at the other end of the scale from all this ‘lifestyle’ cookery, are the people whose diet is so limited as to be dreary, but they have no choice. I’ve been working with Vital Arts to create vibrant tasty recipes for renal patients, people on dialysis.
Dialysis is a full-time job; people with kidney failure must go in to the renal ward for five hours, three times a week. Work is difficult and holidays are virtually impossible. The patients are tired all the time. Dialysis, while keeping them alive, is exhausting: you have all your blood taken out, cleaned and put back in. During the process, you feel at your most vulnerable, the life blood is literally being drained out of you. Most renal patients have diabetes. The diabetes explosion in the West will inevitably lead to a surge in demand for dialysis a few years down the line.
There aren’t enough kidneys for transplant. Immediately after my visit, I signed up online to donate my organs. Do it.
Most of the patients on the dialysis ward at the Royal London Hospital, the largest in Europe, are from ethnic minorities: African, Caribbean and from the Indian sub-continent. One of the reasons for this is that there are less donated organs from ethnic minorities and cross-racial organ donation often don’t match for both blood and tissue types. Ethnic minorities wait longer for organ donation and spend longer, often years, on dialysis.
The renal diet is very restrictive. No potassium, no salt, and about half a litre of liquid a day, including all the liquid they have in their food. Sufferers are reduced to sucking ice cubes to allay thirst. Their kidneys have shut down and they cannot process the excess liquid. No potassium means for instance, no bananas, no yams, few nuts, few tomatoes, a tiny amount of coconut milk. Potatoes must be boiled and drained then cooked again, to rid them of potassium. And imagine a life without salt. In addition, the fact that most renal patients are diabetic means that they must restrict sugar, fruit and carbs in their diet as well as fat: double whammy.
The people on the ward tend to go in for dialysis with the same people, on the same shift, every week, so they get to know each other really well. They develop close relationships, especially those that are picked up and dropped off by NHS bus, spending three days a week with each other. One of the favourite topics of conversation is food, so Vital Arts asked me to create some recipe cards of dishes that they could eat. The official NHS diet sheets tend to feature British food; in fact the over-boiled, bland food that the British have been trying to move away from, is exactly what a renal patient should be eating. But as dialysis patients come from different cultures, they want more inspirational recipes, dishes they can salivate over. At the same time the recipes should be fairly simple, for people on dialysis have little energy to cook.
I went along to chat to some patients about the food they like and came up with three recipes. Vegetables and fruit are a problem for people on dialysis, they contain too much fluid. Therefore it is easier to have a protein based, meat diet. So one of the recipes is a chicken recipe, which has been tested. It’s the only meat recipe I’ve ever included on this blog.
Finally there was an excellent recipe given by a lady of Nigerian origin, a yam chips and tomato stew: she convincingly told us that her Nigerian diet was fine for people on dialysis. But the NHS dieticians said no, it was far too high in potassium. All of the below recipes were checked by the NHS dieticians, I was told to use less oil, less olives, to boil vegetables then drain the water away before using them.

Shamim’s Chicken Tagine with ras el hanout

Shamim, 54, is originally from Pakistan. She’s been in the UK for 35 years. Her husband has his own business selling gear boxes for cars and Shamim used to work for him. She has been on dialysis for one year now. Her daughter and her daughter-in-law, from Dubai, cook for her but are careful to comply with her diet.
This is a recipe from her daughter-in-law. It’s spectacular, a feast for a family and uses a North African cooking pot called a tagine. This is shaped like a cone, condensation runs up the insides and back down into the food. If you don’t have one, you can use a shallow casserole dish with a lid or, as many modern North Africans use, a pressure cooker.

This can be ground and used for several weeks if kept in a dry place. Every Arabic shop has it’s own spice mixture, here is a standard approximation of this recipe. Ras el hanout means from the best in the shop. 2 sticks of cinnamon,10 cloves1 tbsp of coriander seeds1 tbsp of cumin seeds1 tbsp of fenugreek seeds1 tbsp of fennel seeds1 tbsp of brown mustard seeds2 tbsp of dried rose petals

Dry roast all of the ingredients except for the rose petals in a heavy bottomed frying pan, making sure you do not burn the spices. You want the oils and flavours of the spices to emerge.Then grind all of the ingredients in a powerful blender or a pestle and mortar.

Method for the tagine:

Heat up your tagine or shallow casserole on a medium heat and when it has reached temperature, turn down the heat to low. First brown the chicken pieces in the oil, then place all the ingredients in the tajine, in order, with the chicken on top in your cooking vessel. Then add the rest of the ingredients. Cook for about an hour. If cooking in a casserole, first brown the chicken pieces in the oil, then layer up the casserole dish and bake at 160º for 1 hour 15 minutes. (If using a pressure cooker, follow the manufacturers instructions)

Garnish with parsley and rose petals. Serve with couscous.

Selina’s Bangladeshi Fish Curry

Selina is 48,
originally from Chitagarh in Bangladesh. She has been on dialysis for just over a year. She’s been in the UK for 25 years, coming here as a 15 year old with her
sister. Her sister died ten years ago. She’s done several jobs while in the UK,
worked in a shoe shop, in sweet shops and in a dry cleaners. She is helped by
an English gentleman, a pensioner from the East End, who sometimes accompanies
her to hospital for her dialysis, and cooks for her. He cooks typically English
food which is rather bland, but good for a renal diet. But this is a favourite
dish of hers, from her country.

Serves 2

1 tbsp sunflower or olive oil or mustard oil

1 tbsp of turmeric powder

400g of tilapia fillets, washed and patted dry
with kitchen paper

1 tbsp of vegetable oil

A pinch of red chilli powder (optional)

1 bay leaf

4 green cardamom pods, crushed

1 tsp of cumin seeds

2 cloves garlic, minced

1 brown onion, finely diced

1 whole green chilli, deseeded, sliced thinly

1 thumb of fresh ginger, peeled and finely
chopped

1 tsp of ground coriander

1 tsp of ground cumin

1/2 tsp of turmeric powder

2 tomatoes, chopped finely

a handful of fresh coriander leaves, picked
from their stems

Juice of half a lime.

Rub the turmeric powder and oil over the fish fillets
and leave to marinate for ten minutes. Pre-heat the grill and grill the tilapia fillets until golden on each side. Handle them gently
as you do not want the fillets to break up. Once cooked, lift out the fillets
and set aside.

In a frying pan, fry the oil, red chilli powder if using,
the bay leaf, green cardamom, and cumin seeds.

Stir on a medium heat for five or so
minutes, then add the tomatoes. Cook for another five to ten minutes then add
the tilapia fillets. These should take around five or so minutes to cook.
Garnish with coriander and a squeeze of lime.

Serve with chapatti.

Kalla’s Kiri Hodi

Kalla, 51, was
brought up in Sri Lanka and Malaysia. She’s suffered from high blood pressure
since her early 20s, hence she has been on dialysis for four years in the
self-care section.

The renal diet means no nuts, no seafood, no
aubergines, all of which are extensively used in the Malaysian and Sri Lankan
food of her youth but Kalla occasionally has some as a treat when her
mother comes to visit. Asian fruit and vegetables are particularly high in
potassium.

String hoppers are a kind of steamed rice cake like idli. One requires a mould and a basket or pallet to steam them.

But for this recipe, we have used rice noodles or you could serve rice.

Kalla’s mother makes her own chilli powder. She
grows her own chillies and takes it to a local miller, where they ground spice
mixtures in small batches.

Note: liquid is obviously a problem with the
renal diet so only a small amount of the Kiri Hodi gravy must be eaten.
Generally a dry curry is best for those on dialysis.

This meal is eaten for breakfast or dinner.
Hoppers are one of the most ancient foods, dating from the 1st century.

Kiri Hodi with String Hoppers or rice noodles

Serves 2

String Hoppers

225g of plain flour or white or roasted red rice flour
(available at Indian shops)

A pinch of salt

335ml of hot water

Kiri Hodi

400g of King Fish

1/2 a red onion, thinly sliced

1 small green chilli, deseeded, sliced thinly

3 -4 fresh curry leaves

2 garlic cloves, minced

1/2 tsp ground turmeric

1 cinnamon stick, whole, removed from sauce before serving

1/4 tsp of fenugreek seeds, dry roasted

50ml coconut milk

200ml of soy milk

Juice of half a lime

Garnish: fresh coriander

String hopper method:

Prepare a double boiler/ bain marie steamer
with hot water just enough water to rest below where you will place the string
hopper baskets.

Mix the flour and salt in a bowl then add the
hot water, mixing it together. Do the ‘ball’ test. If you can press the crumbly
dough into a large ball then you have the right texture. It shouldn’t be too
wet however. It is important to knead the dough while it is hot. If the dough
is too hot for your hands then empty the dough into a ziplock bag and knead it
with a tea towel.

Knead the dough until it is fully mixed with no
lumps.

Using a string hopper mould, place the dough
into the gadget and squeeze out the noodles onto the string hopper pallet or
basket, using a circular motion.

Place the pallets of noodles into the double
boiler and steam the noodles over the boiling water for 5 to 10 minutes.

Kiri Hodi method:

Put all the ingredients except for the lime
juice in a saucepan on a medium heat and let it cook for about 5 minutes. Then
add the lime and a pinch of salt, bring up to a boil then switch off. Keep
stirring and serve with string hoppers.

Fascinating topic and one that makes me feel a bit guilty about my casual attitude towards food. My father died of renal disease but he was never given a proper diet to follow. Excellent work, Kerstin. I am sure this will be helpful to lots of people.

Some well put comments about the ubiquity of aspiration and tweeness. This is a truly great post and I really appreciate the time and energy invested in so many personal stories. Particularly welcome is Shamim's tagging and the reminder about el hangout spice mix. Kiri Hodi also looks lovely. Hoppers, wow! Thanks to all the contributors.

Thank you for working so hard to help those suffering. Such a restricted diet, not to mention the dialysis itself, is suffering indeed. I agree the pictures are wonderful. Thanks again! Christina in the US

Easy to get sucked into the 'string round the cookies' kind of food photography. Personally like more honest food pics – and then it's more about the food than the (fake) lifestyle. A friend has had 3 kidney transplants and was on dialysis for a while – I witnessed what a toll it took on her and how incredibly time consuming it is ….just to stay alive. To have that burden plus a restriction on your eating habits sounds pretty unbearable. I love how you've turned your resourcefulness and imagination to this project. Great stories behind the pictures and recipes. I've had a kidney donor card forever and still carry it when in the UK. I don't understand why people object to the 'opt out' rather than 'opt in' sort of scheme. It would transform so many lives. Great post Kerstin.

Thanks Sally. I also have a weakness for twee food pix. In fact I think I even have a lovely pix of home-made biscuits tied with some fashionable twine! The really worrying thing is that ethnic minorities don't donate organs. I have no idea why. Jehovahs witnesses? And I guess there are less available ethnic minority organs in general in the UK as they are but 14 % of the population.

What a great project. In Australia our Aboriginal people have a shamefully high rate of dialysis. There are cultural reasons for it that are incredibly complex – one of my favourite stories of resilience in the Aboriginal community is how they brought dialysis to a remote community through an art auction – https://www.westerndesertdialysis.com/our-story/history – but now your story makes me wonder about issues of nutrition and how they affect dialysis patients too.

Thanks for your comment Johanna. What kind of diet do aborginals tend to have? I imagine those that stick to a traditional diet don't have kidney problems? Why do they tend to have dialysis? I've never been to Australia, and that is something I MUST rectify.

I love this post. My mom was born with polycystic kidney disease and spent 6 years on peritoneal and the last 6 months of her life on haemodialysis so I am horribly familiar with the toll dialysis takes. Dietary advice from her renal specialist was minimal so she had to find out all this info the hard way. I love all three recipes as well as the personal stories behind them.